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호주 의사 2년차 라이프 30

혈구탐식성 림프조직구증식증hemophagocytic lymphohis- tiocytosis HLH

HLH.  아주 흔하지 않은데 그래도 발병하기에 DDx에는 끼어넣어야하는 질환. Introduction and epidemiology Hemophagocytic lymphohistiocytosis (HLH) is a disease with major diagnostic and therapeutic difficulties. HLH comprises two different conditions that may be difficult to distinguish from one another: a primary and a secondary form1)Primary HLH-The primary autosomal recessive form, familial hemophagocytic lymphohistiocytos..

항인지질증후군/항인지질항체증후군 Antiphospholipid syndrome (APLS, APS)

피곤하고 왼쪽 가슴 아래 쪽이 아파 왔는데. splenic infarct이었다. 이유는 APLS 였다. Lupus anticoagulant test  positive+ splenic infarct . clexane + warfarin bridging 하며 퇴원.  Clinical manifestations 1) Thrombotic events -The hallmark of APLS : venous thromboses are more common than arterial thromboses -The risk of both venous and arterial thrombosis and/or thromboembolism is increased in individuals with positive tests fo..

폐색전증 Pulmonary embolism

HFrEF 가 background 로 있지만 fluid overload 없이 worsening SOB on exertion 으로 입원했다. D-dimer 는 13. mild AKI 가 있었지만 그래도 CTPA.  결과는 PE. 거기에 LV thrombus 도 CTPA 에서 incidental finding. cardiology input 도 같이 들어감.  Risk factors 폐색전증 위험요인 -More than 48 hours of immobility in the preceding month – 45 percent-Hospital admission in the past three months – 39 percent-Surgery in the past three months – 34 percent-M..

면역매개 괴사근육병 immune-mediated necrotising myopathy IMNM

정말 흔하지 않다. STICK 을 쓰고 걸었고. Antibodies 는 모두 negative 였는데 muscle biopsy 에서 positive. Significant Proxmial weakness >distal weakness 였고 Mycophenolate mofetill 1g BD 를 썼다 pred 쓰다가 weaned off Response to therapy should be assessed clinically on the basis of muscle strength and biologically on CK levels. IMNM is the most severe idiopathic inflammatory myopathy in terms of muscle damage, and relapses a..

Systemic sclerosis 전신 경화증

이번주는 류마토이드 내과. 첫날인데 전신 경화증 systemic sclerosis 환자가 입원했다 - systemic scelrosis with overlap syndrome (rheumatoid arthritis) 아주 여러문제가 있어서 겸사겸사 모두 해결해보고자. 류마티스 내과 에 입원하는경우는 정말 흔치 않다. 앤간하면 보통 gen med 에 입원하고 우리는 consult 보는 정도. Systemic sclerosis (SSc) -a chronic multisystem disease characterized by widespread vascular dysfunction and progressive fibrosis of the skin and internal organs-is a heterogeneo..

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